Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recently, conventional therapies for inflammatory bowel disease (IBD) have not received the same amount of attention as biologic therapies, yet they remain the backbone of therapy for IBD because of their efficacy, safety, and relatively low cost. Advances in efficacy and safety continue because of modifications in drug dosing and monitoring. Higher doses of mesalamine per pill, together with once-daily dosing, may help to optimize drug delivery and patient compliance. Budesonide, an effective agent for both induction and short-term remission maintenance in Crohn's disease, is devoid of many of the toxicities common to corticosteroids. Assessments of thiopurine methyltransferase and metabolite levels are helping to fine-tune dose optimization for the thiopurines azathioprine and 6-mercaptopurine. The oral calcineurin inhibitors tacrolimus and cyclosporine have been shown to have expanded roles in IBD, and methotrexate may be useful in some patients with refractory ulcerative colitis. Probiotics are showing promise for maintenance of remission in Crohn's disease, ulcerative colitis, and pouchitis.
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PMID:Optimizing conventional therapy for inflammatory bowel disease. 1900 15

Crohn's disease is a type of inflammatory bowel disease that frequently affects the ileo-cecal region of the gastrointestinal tract. For effective treatment of this disease, a site-targeting drug in the ileo-cecal region is essential. Budesonide (BD) is a synthetic, non-halogenated glucocorticoid and is the drug of choice for the treatment of Crohn's disease. The present study is an attempt to develop the dosage form of a BD tablet to achieve targeted drug release in the ileo-cecal region. The BD tablets are coated with Eudragit FS 30 D, which is a polymer that specifically dissolves at and above pH 6.8. The in vitro drug release and in vivo tablet disintegration (using X-ray radiography) were carried out. The coating process was optimized successfully. The in vitro performance of the tablet with coating thickness showed that the tablet did not disintegrate till 4.5 hours, which represents the transit time to the ileo-cecal region. In vivo studies also established that the tablet lasted till 4.5 hours. The tablet containing 0.5% superdisintegrant and 10% coating thickness was able to deliver BD effectively to the ileo-cecal region, thus making it a promising drug delivery system for the treatment of Crohn's disease.
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PMID:In vitro drug release and in vivo human X-ray studies of ileo-cecal targeting budesonide fast disintegrating tablet. 1933 70

Crohn's disease is characterized by recurrent transmural inflammation of the gastrointestinal tract, most commonly, the terminal ileum and the colon. Therapy is aimed at breaking the cycle of inflammation by inducing and maintaining remission. Current effective therapies include systemic corticosteroids, but this class of drugs is associated with a variety of adverse effects, which may lead to significant morbidity and even mortality. Budesonide, a potent corticosteroid designed to have location specific delivery to the gastrointestinal tract, has limited systemic bioavailability largely due to its extensive first pass metabolism and has been demonstrated to be a safer alternative to conventional corticosteroids and of proven efficacy in the induction of remission in mild to moderate Crohn's disease. However, budesonide is not effective in maintaining remission in patients with Crohn's disease.
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PMID:Budesonide for Crohn's disease. 1961 1

Step-up therapy in Crohn's disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where biologicals together with thiopurines were used as first-line therapy. Several arguments exist against the top-down therapy. The current ECCO recommendation is in favor of the step-up therapy. ECCO recommended budesonide 9 mg daily as the preferred treatment in mild to moderate Crohn's disease patients. The benefit of mesalazine in small bowel disease is limited and should be considered clinically no more effective than placebo. Antibiotics cannot be recommended unless septic complications are suspected. No treatment is an option for some patients with mild symptoms. Budesonide is preferred to prednisone for mild active Crohn's disease because it is associated with fewer side effects. Active mild colonic disease may be treated with sulfasalazine and when needed with systemic corticosteroids as well. Topical treatment should be considered for distal disease. The national cooperative Crohn's disease study and the European co-operative Crohn's disease study established corticosteroids as an effective therapy for inducing remission in Crohn's disease. Remission is achieved in 60-83% of the patients. A Cochrane review of the efficacy of azathioprine and 6-mercaptopurine for inducing remission in active Crohn's disease showed a benefit for thiopurine therapy compared with placebo. Methotrexate is another effective medication that has been confirmed in a systematic review. Once remission has been achieved with systemic corticosteroids, maintenance with azathioprine should be considered. For patients with extensive colitis, long-term treatment with mesalazine is an option as this may reduce the risk of colon cancer, although this is still unproved in Crohn's disease. In conclusion, the natural course of most patients with Crohn's disease is relatively mild and there is a room for step-up therapy. The efficacy of most medications is similar to the efficacy of infliximab but with less adverse effects. Infliximab should be reserved only for patients where other therapies failed.
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PMID:Mild to moderate Crohn's disease: still room for step-up therapies? 1978 63

Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, features recurrent episodes of inflammation of the GI tract. The treatment of inflammatory bowel disease is aimed at breaking the cycle of relapsing and remitting inflammation by inducing and maintaining remission. Systemically active conventional corticosteroids have long played a role in the induction of remission in both Crohn's disease and ulcerative colitis, however, their long-term use can lead to adverse systemic effects. Budesonide, a synthetic steroid, has potent local anti-inflammatory effects and limited systemic bioavailability making it an appealing therapeutic option. Ulcerative colitis with predominantly distal disease may be treated with topical budesonide, however, novel oral controlled-release formulations have also been developed to allow for treatment of the entire colon. This article summarizes the use of budesonide in the management of inflammatory bowel disease.
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PMID:Budesonide in the treatment of inflammatory bowel disease. 2179 Feb 84

Crohn's disease and ulcerative colitis are inflammatory bowel diseases characterised by a chronic relapsing course. Corticosteroids represent the mainstay of medical treatment of inflammatory bowel disease for the induction of remission. Despite the high efficacy of systemic steroids, their use is limited by the high incidence of potentially serious adverse effects. The topically acting steroids are synthetic compounds characterised by high anti-inflammatory activity and low systemic effects by virtue of efficient first-pass hepatic inactivation. Budesonide and Beclomethasone Dipropionate are the two most studied topically acting steroids in inflammatory bowel disease. Oral Budesonide has been extensively studied in the treatment of mild to moderate ileo-caecal Crohn's disease but few data are available concerning oral Beclomethasone Dipropionate. This review focuses on the available evidence of efficacy and safety of oral Beclomethasone Dipropionate in the management of ulcerative colitis and Crohn's disease and a possible role of this steroid in clinical practice is suggested.
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PMID:Oral beclomethasone dipropionate: a critical review of its use in the management of ulcerative colitis and Crohn's disease. 2243 45

Budesonide is a synthetic steroid of the glucocorticoid family with a high topical anti-inflammatory activity. Enteric-coated formulations resist gastric-acid degradation, delivering active drug to the small intestine and proximal colon. Budesonide has a high first-pass metabolism with minimal systemic absorption. It is therefore felt to cause fewer side effects than traditional glucocorticosteroids and to be generally well tolerated. The aim of this paper is to examine the utility of this medication in frequently encountered gastrointestinal conditions: Crohn's disease, ulcerative colitis, microscopic colitis and eosinophilic oesophagitis. A Medline search was performed to find published original research and review articles relating to the use budesonide in common gastroenterological conditions. The results showed that budesonide is efficacious in the induction and short-term maintenance of Crohn's disease. Budesonide is the best-documented treatment for microscopic colitis. It is well proven to be effective in the induction of remission in collagenous colitis but its use in lymphocytic colitis remains less well documented. In conclusion, budesonide is an effective glucocorticosteroid therapy for many chronic gastrointestinal diseases. In combination with its efficacy, the low incidence of serious side effects associated with this drug should keep it at the forefront in the therapeutic arsenal of any gastroenterologist.
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PMID:Therapeutic benefits of budesonide in gastroenterology. 2325 37

: The antiinflammatory effects of glucocorticosteroids (GCS) in inflammatory bowel disease (IBD) are unsurpassed by those of any other type of drug, but the beneficial effects are often offset by troublesome, and sometimes irreversible, systemic side effects. Improved GCS have been developed with the aim of obtaining improved topical action, with reduced systemic side effects. A high tissue uptake and a high affinity for the GCS-receptor in combination with a rapid and extensive biotransformation in the liver are key prerequisites. Budesonide appears to be the most promising of the new topical GCS for IBD. In enema form it is already in clinical use for active distal ulcerative colitis (UC), with efficacy similar to that of conventional GCS but with no appreciable impact on adrenal gland function. Oral, slow release preparations of budesonide are efficacious in the treatment of active ileocecal Crohn's disease (CD), causing less suppression of endogenous plasma cortisol levels than does oral prednisolone, and giving rise to fewer, and less severe, side effects. Budesonide may also have a role for prevention of clinical relapse in certain groups of patients with CD, and is currently under evaluation for extensive and left-side UC. Long-term studies addressing issues such as impact on bone metabolism are currently in progress. Future development of GCS for IBD includes factors such as improved topical delivery systems, enhanced tissue uptake, and even more extensive first pass metabolism.
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PMID:New steroids for inflammatory bowel disease. 2328 5

Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroid-based drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.
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PMID:Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity. 2350 68

Budesonide is a corticosteroid characterized by high topical activity and low systemic effect associated with fewer glucocorticoid-related adverse events than conventional steroids. Differently from Crohn's disease, no evidence suggests that oral budesonide is effective for the induction of remission of ulcerative colitis (UC). Budesonide multi-matrix (MMX) system is a new oral preparation that, by employing a MMX, provides the release of the drug throughout the entire colon. Its efficacy in inducing UC remission, at a dose of 9 mg, is based on some recent trials. However, in two studies the absolute differences between budesonide MMX and placebo were much lower than the rate of success reported in previous trials with mesalazines. In addition, the therapeutic advantage of budesonide MMX 9 mg over 5-aminosalicylic acid (5-ASA) showed by one study, and the advantage of budesonide MMX over budesonide reported in the other study, was only 5.8 and 4.8%, respectively. The evidence supporting the use of budesonide MMX at a dose of 6 mg for maintenance is weak. Therefore, the effective dosage should be 9 mg also in maintenance, but not for > 4 - 6 months, because a prolonged treatment has showed to increase the rate of side effects.
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PMID:Budesonide multi-matrix system formulation for treating ulcerative colitis. 2448 92


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